Report Produced: 02/04/2023 17:37 PM
|Report||Question ID||Question||Discussion||Answer (Descending)|
|20051078||Surgery of Primary Site--Melanoma: If the surgical margins are greater than 1 cm for length and width but less than 1 cm for depth, do we code surgery in the 30-33 range?||Yes, assign a surgery code from the 30-33 range when any margin is less than 1 cm. Since tumor thickness is an important prognostic factor for cutaneous melanoma, the deep margin is of particular importance.|
|20061086||Reportability--Melanoma: Is an excisional biopsy of the skin with a diagnosis on the pathology report of "Tumoral melanosis" reportable by itself or must there be a pathologist note, such as "Note: Unless proven otherwise, tumoral melanosis should be considered as a regressed melanoma", in order for it to be considered reportable? See Discussion.||
Skin, left upper back, exc Bx: Tumoral melanosis. Note: Unless proven otherwise, tumoral melanosis should be considered as a regressed melanoma.
If reportable, do we report a diagnosis of tumoral melanosis without a similar note?
|Tumoral melanosis (TM) alone is not reportable. It is not listed in ICD-O-3. TM can be associated with a regressed melanoma, but it can also occur with other cutaneous tumors. The case is reportable if there is a diagnosis of melanoma.|
Reportability--Melanoma: Is the following reportable? See Discussion.
|PATH: Skin, Lt back exc bx: compound nevus with severe cytoarchitectural atypia and regression. Comment: due to overlap of morphology between MM and nevi with severe atypia, and since there's evidence of regression, consideration for re-excision may be considered if clinically indicated.||The final diagnosis, compound nevus with severe atypia, is not reportable. This diagnosis is not listed in ICD-O-3.|
|20081055||MP/H Rules--Melanoma: How many primaries are represented if subsequent to a diagnosis of malignant melanoma of skin of left thorax in April 2006, a metastatic melanoma is discovered in the soft tissue of the abdomen and in the skin and subcutaneous tissue of the groin in late 2007? See Discussion.||
4/20/06: skin left lateral thorax, excision: Pedunculated malignant melanoma, 0.5 CM in height, Clark's level 3, Breslow depth 0.5 CM, superficial ulceration noted. No host response. Margins clear.
6/19/06: Four sentinel LNs negative. Interferon therapy.
10/30/07: FNA of soft tissue, left lower abdomen: consistent with metastatic melanoma.
12/20/07 A) sentinel lymph node, left groin, biopsy: No morphologic or immunophenotypic findings support for metastatic melanoma (see comment). B) skin and subcutaneous tissue, left groin, excisional biopsy: Metastatic malignant melanoma (see comment). Lymphovascular invasion identified. Margins free of melanoma. Melanoma 1.5 MM from the closest designated deep margin and 5 MM from the designated 6:00 margin. C) skin, left groin/additional inferior margin, excisional biopsy: No significant histopathologic abnormality. No evidence of villus or melanoma or malignancy. Comment: A 0.8 cm metastatic nodular melanoma is present in the adipose tissue. The underlying skin is unremarkable. There is no evidence of ulceration, melanocytic lesion, melanoma in situ, or regression of melanoma. Block A1 is sent for immunohistochemical studies. The immunophenotypic findings provide no support for metastatic melanoma in lymph node. Please see the immunohistochemical study. The primary MD states "Recurrent intransit mets, left groin."
|For cases diagnosed 2007 or later, this is a single primary, melanoma of the thorax 4/20/06. The subsequent reports mention metastases, but do not document another primary. Do not count metastatic lesions as new primaries.|
|20100007||MP/H Rules/Histology--Melanoma: Regarding SINQ #20081044, when would you apply Rule H6 rather than Rule H5 for a cutaneous malignant melanoma given that you normally always have a specific cell type mentioned?||For cases diagnosed 2007 or later, Rule H6 is used when you do not have a specific cell type other than regressing melanoma, or malignant melanoma, regressing. If you have regressing melanoma with a specific cell type, apply rule H5.|
|20061051||Reportability--Melanoma: Is the final diagnosis for an excisional skin biopsy of "compound nevus with severe cytoarchitectural atypia and regression" considered reportable if a re-excision may be clinically indicated because there is an "overlap of morphology between malignant melanoma and nevi with severe atypia, and there's evidence of regression"?||Compound nevus with severe atypia is not reportable unless also stated to be malignant melanoma or melanoma in situ.|
|20051103||CS Extension/Histology (Pre-2007)--Melanoma: When do the terms "regression is present," "apparent regression," or "undergoing regression" affect the coding of melanoma cases? See Discussion.||
For melanoma, many path reports document the presence or absence of regression. At what point does the presence of regression become significant enough to code it for histology and for CS Extension?
Example 1: Skin biopsy showed malignant melanoma, Breslow thickness 0.38 mm, Clark's level II, ulceration is absent, regression is present.
Example 2: Punch biopsy showed malignant melanoma, Clark's level II, 0.34-mm maximum depth of invasion, with apparent regression.
Example 3: Skin biopsy showed lentigo maligna undergoing regression.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
For tumors diagnosed prior to 2007:
Regression does not affect CS staging for cutaneous melanoma. "Malignant melanoma, regressing"  is coded only when it is the final diagnosis. Do not use code 8723 for the examples above.
According to our pathologist consultant:
Melanoma can occasionally undergo "spontaneous" regression -- the tumor can become smaller, and in some cases even disappear. This phenomenon is likely due to an increased immune response on the part of the "host" (person with the melanoma). This is noted occasionally in patients with metastatic disease which gets smaller, or even disappears. We think this is also what has happened in patients who get diagnosed with metastatic melanoma, say in a lymph node, but have no primary tumor, though sometimes give a history of a skin lesion which came and then went away, or a skin lesion which was not submitted for pathological examination. In addition, we (pathologists) occasionally see biopsies which have melanoma as well as the presence of the immune reaction to it, and once in a while, the immune reaction with little or no evidence of residual melanoma.
The College of American Pathologists says that regression of 75% or more of the melanoma carries an adverse prognosis.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Solid Tumor Rules (2021)/Laterality--Melanoma: Will the table called Site for Which Laterality Code Must Be Recorded be updated in the 2021 SEER Program Coding and Staging Manual as C444 is not included? The 2021 Cutaneous Melanoma Solid Tumor Rules say that C444 requires laterality; it says (new) beside it on the new Solid Tumor Rules for 2021.
The laterality table in the 2021 SEER manual will not be updated. Please follow the 2021 Cutaneous Melanoma Solid Tumor Rules and assign a laterality for C444.
Solid Tumor Rules (2018, 2021)/Histology--Melanoma: In what situation will Rule H6 be used to code the histology to lentigo maligna melanoma? See Discussion.
Rule H6 states: Code 8742/3 (Lentigo maligna melanoma) when the diagnosis is lentigo maligna melanoma with no other histologic types. However, if the diagnosis was strictly lentigo maligna or lentigo maligna melanoma, the first rule that applies is Rule H1 because lentigo maligna melanoma is a single, specific histologic type and Rule H1 states, Code the histology when only one histologic type is identified. Following the current rules, one would never arrive at Rule H6. Should the H Rules be reordered? Or should an example of when one would use Rule H6 be added to clarify when to use this rule?
Solid Tumor rule H6 is the same as MP/H rule H8. We found registrars have problems understanding reportable terminology and the corresponding ICD-O-3 histology code for lentigo maligna melanoma. It is included in H6 to capture cases where the registrar may not stop at H1. We will add another note to H1 instructing users to continue through the rules if the diagnosis is lentigo maligna melanoma.
MPH Rules/Multiple primaries--Melanoma: Does MP/H Rule M7 (diagnosed more than 60 days apart) apply to invasive melanoma cases with margins positive for in situ melanoma, or are these further excision of the original diagnosis and the same primary, even when it appears treatment was complete after the initial excision? See Discussion.
A dementia patient has been managed for a persistent right cheek skin lesion that has been slow growing for about 5 years. It was biopsied in 12/23/15 revealing a Breslow 0.12 mm lentigo maligna melanoma by an outside provider. A larger resection of the lesion on 2/3/16 demonstrated a Breslow 0.30 mm lentigo maligna melanoma with melanoma in situ present at the margins per the available pathology report. There was no statement in the record that any additional treatment was planned or necessary.
Patient healed well from the 2/3/16 procedure but developed a recurrent lesion in May that was biopsied on 5/10/16 by the same outside provider which again reveal lentigo maligna melanoma. 7/5/16 Reexcision at the current facility revealed a Breslow 6.1 mm lentigo maligna melanoma, Clarks level V. This was a cutaneous tumor per the path report and not a subcutaneous nodule. Clinically, the MD called this a , but there was no slide comparison to the previous melanoma.
In auditing files for expected (but not received) abstracts due from facilities, we've observed these types of cases not being consistently reported as multiple primaries.
Rule M7 pertains to separate tumors. Rule M7 does not apply to invasive melanoma cases with margins positive for in situ melanoma.
Based on the information provided, it is not clear whether or not the 5/10/16 diagnosis is a separate lesion or the same lesion that was diagnosed earlier.